African American Rhinoplasty
Below is a video on African American Rhinoplasty, Tip Shaping Refinement, Bulbous Tip Refinement, Transdomal Suturing, Interdomal Suturing, Changing the Lateral Crura:
African American Rhinoplasty requires a unique understanding of the anatomy of the African American Nose and ethnic distinctions unique to this population that one may want to preserve. The African American Nose is typified usually by a thick skin envelope, weaker cartilages (lower lateral tip cartilages), a bulbous tip, wide base | wide nostrils, less tip and nose projection, acute nasolabial angles. The Thick Skin Envelope makes it harder to refine the tip. Even with a strong tip complex or strong cartilages outlining the basis for the tip's appearance, the thick skin envelope makes it harder to reveal these structures. The solution is to thin the skin envelope or to make the cartilaginous structures smaller. The Weaker Cartilages of the African American Nose can make it hard to project the tip and to refine the tip. Sometimes, the cartilages are weak to the point of being fragmented, missing, flimsy, and absent. The solution is to replace the weaker components with stronger cartilage. One way to do this is to put in a caudal extension graft that extends from the septum to the lower lateral cartilages that is used to support them and hold them in the right position. This connection to the septum is strong because it places cartilage there to fill in and hold the new position. In the past, columellar strut grafts were the thing people most used but this often lacked appropriate strength in our experience. These grafts did not connect to the septum and were dependent on their own strength. A connection with the septum is very powerful and this is why we prefer a caudal extension graft.
Below are some images of a Rhinoplasty performed by Dr. Philip Young on an African American Patient with a droopy, bulbous tip. The tip lacked projection and rotation. In the after images, the tip shows more rotation, projection and refinement. The after pictures were taken 7 months after the patient's procedure.
Below is a picture of the location of a caudal extension graft in blue. The green outlines where the caudal and dorsal edges of the septum are located. As you can see the caudal extension graft is overlapping the septum and connected at the overlap region. This connection gives the caudal extension graft a lot of strength for the tip to be based on. The tip cartilages are set over the caudal extension graft in a new projected position. Based on how the caudal extension graft is shaped you can change different things about the tip. The retractors is holding the tip skin back to expose the tip cartilages in the below image. You can click here to see more Before and After Rhinoplasty Images:
|Before African American | Ethnic Rhinoplasty for Bulbous Tip, Tip Refinement and Projection||After African American | Ethnic Rhinoplasty for Bulbous Tip, Tip Refinement and Projection|